BackgroundScleroderma is a systemic autoimmune disease characterized mainly by skin manifestations and involvement of various visceral organs, especially the lungs. Lung involvement is the leading cause of mortality in patients with scleroderma. There are data to suggest that cyclophosphamide (CYC) and mycophenolate mofetil (MMF) are effective in the management of scleroderma interstitial lung disease (SSc-ILD) but no head to head comparative data are available to date.MethodsFor the last 3 years, patients with SSc-ILD have been treated at our centre by protocol-based administration of intravenous CYC and MMF. Results of lung function tests (spirometry) were recorded at baseline, 3 months and 6 months in every patient. The clinical records of patients with systemic sclerosis and significant ILD, who were not previously exposed to any immunosuppressant and were treated with MMF OR CYC, were reviewed. The efficacy of treatment was assessed by the change in forced vital capacity on spirometry.ResultsOf the total 57 patients included in the analysis, 34 were treated with MMF and 23 were treated with CYC. Mean duration of illness was 4.19 ± 2.82 years in the MMF and 6.04 ± 5.96 years in the CYC group. After 6 months of therapy, FVC increased by 10.84 ± 13.81 % in the CYC group and by 6.07 ± 11.92 % in the MMF group. This improvement from baseline was statistically significant in both groups (P < 0.01). The improvement was comparable with no statistically significant differences between groups (P = 0.373). There were no major adverse events reported in either arm.ConclusionBoth MMF and CYC were equally effective in stabilizing lung function in patients with scleroderma and ILD.
BackgroundRituximab is an anti-CD20 antibody that represents a therapeutic alternative for the patients with rheumatoid arthritis. It has been proven that Rituximab at a dose of 2 gm is very effective in patients with DMARD and antiTNF failures. But the cost of this therapy is high and increases the economic burden. Limited data has shown that B cell is possible even with lower dosage to what is recommended.Objectives1) To assess B cell depletion with very low dose single dose of 100mg Rituximab2) To assess improvement in disease activity (EULAR response)MethodsIn this open label, prospective, observational study at tertiary care center sero positive RA patients who responded inadequately to combination of DMARDs were given single dose of 100 mg of Rituximab. B cell numbers in the peripheral blood was assessed by Flow cytometry and B cell depletion was defined as B cell numbers <0.01%. Efficacy was evaluated using B cell depletion after 2 weeks and disease activity score in 28 joints (DAS28) on monthly bases. Those patients who did not achieve B cell depletion and/or EULAR moderate response were given second dose of rituximab 500mg.Results15 patients (13 females and 2 males; mean age 47.7±13.95 years) were included in the study. Mean duration of the disease was 7.3±6.01 years. RF was positive in 14 out of 15 and Anti CCP antibody was positive in all patients. At baseline mean DAS score was 6.14±0.84 and mean CD 19% was 10.69±4.35%. After 2 weeks of Rituximab, B cell depletion was achieved in 12 patients (80%) and mean DAS28 was 2.72±0.57 at the end of 24 weeks. Two patients were given second dose of 500mg Rituximab after 8 weeks of first dose. All patients achieved EULAR good response at the end of 24 weeks.ConclusionsEarly results from this study are very promising and show that low dose Rituximab is effective in treating RA patients inadequately responding to DMARDS.ReferencesEdwards JC, Szczepanski L, Szechinski J et al. Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis.N Engl J Med. 2004 Jun 17;350(25):2572-81;Mease PJ, Revicki DA, Szechinski J et al.;Improved health-related quality of life for patients with active rheumatoid arthritis receiving rituximab: Results of the Dose-Ranging Assessment: International Clinical Evaluation of Rituximab in Rheumatoid Arthritis (DANCER) Trial. J Rheumatol. 2008 Jan;35(1):20-30. Epub 2007 Nov 15.Anolik JH, Barnard J, Cappione A et al. Rituximab improves peripheral B cell abnormalities in human systemic lupus erythematosus;Arthritis Rheum. 2004 Nov;50(11):3580-90;Bruzzese V. et al. Therapeutic effectiveness of minimal doses of rituximab in a patient with rheumatoid arthritis; Int J Immunopathol Pharmacol. 2011 Jan-Mar;24(1):265-7AcknowledgementsWe acknowledge flowcytometry lab incharge,chairman-ethics committee and medical director of institute.Disclosure of InterestNone declared
Multiple myeloma is a plasma cell cancer in which antibody-producing plasma cells grow in an uncontrolled and invasive way. The known incidence of multiple myeloma in India ranges from 0.5 to 1.2 per 100,000 & is a rare in India. It usually occurs in persons older than 55 years and the ratio of men: women is 3:2. Multiple myeloma affects the bones, immune system, kidneys and red blood cell count. We report a case of refractory multiple myeloma. [Int J Basic Clin Pharmacol 2012; 1(1.000): 41-42
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.